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NPI Code Detail

MEDICARE: CHANNING HALL APRN, PMHNP

MEDICARE: CHANNING HALL APRN, PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner122833AR

General Provider Information

NPI Number : 1104464445
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANNING HALL APRN, PMHNP
Provider Business Mailing Address
First Line : 3855 LAZY CREEK TRL
Second Line :
City : CONWAY
State : AR
Zip : 72032-9180
Country : US
Telephone Number : 870-814-2689
Fax Number :
Provider Business Practice Location Address
First Line : 2255 STURGIS RD
Second Line :
City : CONWAY
State : AR
Zip : 72034-8029
Country : US
Telephone Number : 501-858-3048
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2019
Last Update Date : 12/17/2019

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